The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

qtLDWVqAKjLQV33e8AkRHbpmt87rVvHcufU8MTYmUcrDZxyIPUkIfxKLG3YDMD7nkBMuXPjwNG3BBW4YmDufFZhrMAafVaQP

Hampton Roads Young Professional Board Application

By serving as a Hampton Roads Young Professionals Board Member, an indvidual will be part of a passionate, outgoing, and philanthropic group. The Young Professionals are a group of young adults who want to make a difference by increasing awareness and education of cardiovascular diseases and stroke, while having fun and making connections.

Please complete the form below to nominate a Young Professional in your organization who you feel could serve as an Ambassador of AHA Young Professionals in making our communities a healthier place.

You may contact hamptonroads@heart.org with any questions about the Young Professionals Board or the application process.

Thank you!

First Name:*	Last Name:*
City:	State:

Cell Number:*

Email:*

Are you completing this form on behalf of a coworker and/or employee?

* must provide value

Yes

reset

Company Name*:	Candidate's Position*:
Candidate's Name*:	Candidate's Email*:

Please describe any current or past experience you feel would make the candidate a good fit for the Young Professionals Board*:

Company Name*:

Your Current Position*:

Please describe any current or past experience you feel would make you a good fit for the Young Professionals Board*:

Please select the skills you feel best describe your candidate*:

Mission

Auction

Fundraising

Sponsorship

Development

Event planning

New Member Recruitment

Social Media

Communications

Human Resources

Other

reset

Please select what bests describes your interests*:

Mission

Auction

Fundraising

Sponsorship

Development

Event planning

New Member Recruitment

Social Media

Communications

Human Resources

Other

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

Hampton Roads Young Professional Board Application

Contact Information

General Information

You have selected an option that triggers this survey to end right now.